The lockdown and social norms: why the UK is complying by consent rather than compulsion

The belief that ‘we are all in it together’ is more important than other factors in explaining why the UK public has complied with lockdown measures so far, early data suggests. Jonathan JacksonChris PoschBen BradfordZoe HobsonArabella Kyprianides, and Julia Yesberg discuss the first findings of a survey on lockdown compliance in ten UK cities.

Throughout the lockdown, calls have centred on the need for collective action: to unite as a community, people need to remain apart as individuals. The roots of what has become an all-too-familiar mantra, ‘stay home, save lives, protect the NHS’, can partly be traced back to the recommendations of one of the Scientific Advisory Group for Emergencies expert groups. Framed as a way ‘to reduce the risk of public disorder’, the advice was that the government should:

‘Provide clear and transparent reasons for different strategies [that]… set clear expectations on how the response will develop… Promote a sense of collectivism: All messaging should reinforce a sense of community, that “we are all in this together.” This will avoid increasing tensions between different groups (including between responding agencies and the public); promote social norms around behaviours; and lead to self-policing within communities around important behaviours.’

The powers that Parliament passed on 26 March were unprecedented, with basic freedoms enshrined in English law on free movement and on free assembly, taken away overnight. The police were tasked to enforce the legal requirement for social distance, yet at the time of writing, public compliance seems to have been remarkably widespread, and the police have rarely had to intervene. By all accounts, in the UK it seems to have been compliance by consent not compliance by compulsion.

How did this happen? As of 26 April there have been over 20,000 Covid-19-associated deaths in UK hospitals. Has adherence to the guidelines been partly about fear of catching the virus? Did making social distancing a legal requirement and the policing of this requirement also make a difference? Was adherence actually only an issue of widely shared norms and values—a simple success for the mantra ‘stay home, save lives, protect the NHS’?

To examine empirically some of the factors underlying people’s levels of lockdown compliance, we started a multi-wave panel study to track the experiences, attitudes, and behaviours of 1,200 people recruited on the platform Prolific Academic—300 living in London and 100 living in each of Edinburgh, Newcastle, Cardiff, Leeds, Liverpool, Manchester, Birmingham, Sheffield and Glasgow.

First wave data were collected on 21 April and it is important to stress that our (convenience) sample is not representative of the 10 cities. The strength of the data lie in our ability to field a large number of measures quickly and our ability to track individuals over time (in the case of this study, every three weeks). By way of benchmark, we are also currently conducting a nationally representative sample survey. However, gathering data from random samples takes time.

To measure compliance in our 10 city study, we asked research participants ‘How often during the past week have you engaged in each of the following behaviours during the Covid-19 outbreak?’:

  • ‘socialised in person with friends or relatives whom you don’t live with?’ (86% said never, 10% said rarely, 2% said sometimes and 2% said often or very often),
  • ‘went out for a walk, run, or cycle and spent more than a few minutes sitting somewhere to relax?’ (62% said never, 15% said rarely, 11% said sometimes, and 11% said often or very often), and
  • ‘travelled for leisure (e.g. driven somewhere to go for a walk)?’ (87% said never, 7% said rarely, 3% said sometimes and 10% said often or very often).

We used a standard form of regression modelling to see which factors explain (what was to us a surprising amount of) variation in self-reported lockdown compliance.

Knowledge and concern about catching Covid-19 is not important

We asked people to rate their knowledge level on Covid-19 and tell us how concerned they were about getting infected. Our analysis indicates that neither knowledge nor fear of catching the virus played a role in explaining differing levels of lockdown compliance (holding constant other factors).

In other words, those who said that they often travelled for leisure, and/or often socialised out of their household, and/or often stopped in the park for a rest or a sunbathe, were not less frightened of catching Covid-19 nor felt less knowledgeable about the virus, compared to people who never or rarely did those things.

Does the law make a difference? Yes, but only with respect to the values and norms that the law expresses

The question ‘does making something illegal and policing the particular law actually make a difference to people’s behaviour?’ is an important one. Beyond incapacitation, the legal system has three levers at its disposal to secure voluntary compliance. The first lever is deterrence. Deterrence models are based on the idea that (would-be) offenders are responsive primarily to the risk of punishment. People comply because they fear getting caught by the police and being punished by the courts. The second lever is legitimacy. A legitimate authority has the right to exercise power: it commands consent that motivates people to be law-abiding citizens. People comply because they feel a moral obligation to obey the police and law.

We found that neither deterrence nor legitimacy (police and legal) predicted people’s self-reported levels of lockdown compliance. But we did find evidence for the third lever: the expressive function of the law. We asked people whether they thought it was right to make social distancing a legal requirement (it is worth saying that under 90% of our research participants said it was ‘right’ or ‘completely right’); whether by making it a legal requirement, the government sent the message that social distancing is important to fight the pandemic; and whether making social distancing a legal requirement helped to clarify what we should and should not be doing. Interestingly, 35% somewhat agreed that making it illegal ‘helped to clarify what we should and should not be doing’ and 53% completely agreed—to us this reflects ongoing debate about ambiguities and mixed-messages in the law, its enforcement, and Government advice.

We found that endorsement of these sentiments predicted lockdown compliance, adjusting for fear of the virus, police and law (and all the other factors). The law, through what it expresses, influences our beliefs and coordinates our behaviour. On the one hand, the content of law expresses to citizens what authorities and other citizens deem to be right or wrong and reveals widespread attitudes towards the behaviour the law regulates. On the other hand, by shaping expectations about how others will behave, the content of law helps to coordinate behaviour: the law helps to create concordant expectations.

In short, our analysis suggests that making social distancing a legal requirement may have strengthened public compliance not through deterrence or legitimacy, but through signalling that the nation needs to take social distancing seriously, underlining what people should and should not be doing, and why.

A story of the power of social norms centred around supporting the NHS

Finally, we found that social norms—the ways people think it is correct to behave and the social pressures this places on them—played a role. We define norms as commitment to (and knowledge of other people’s commitment to) the normative principle that everybody should follow social distancing guidelines. Norms motivate behaviour not only through coordination and cooperation, helping to make people accountable to each other; they also enable people to express shared values, meaning, and identities. Through the take-up of, and adherence to, norms:

we project a certain image and craft a sense of self: of people who care about the dignity of human beings, for whom death is a sombre and serious business, for whom the group is more important than the individual, or whatever.

Unsurprisingly, given the media and political debate, we found that sentiments like ‘most people in my local community would disapprove if some individuals were not strictly following social distancing to help prevent the spread of Covid-19’ and ‘it is important to the National Health Service that everybody sticks to the guidelines on social distancing’ played a central role in explaining lockdown compliance (adjusting for the other factors). Framing the call for collective action to rally behind a beloved institution like the NHS seems to have worked.

Take-home message

At least according to our survey of a convenience sample of people in 10 cities conducted on 21 April, we found that most important to self-reported lockdown compliance was the belief that ‘we are all in it together and we all need to come out of it together’—a sense of common fate, a shared identity, and acting for the common or the social good, centred around national sentiment towards the NHS. Social norms also seem to have been backed up by making social distancing a legal requirement. This may have helped underline how important social distancing is if we are to collectively (as a nation) fight the pandemic. Fear of the virus, police or law were unimportant; neither was the legitimacy of the police or law.

Our results may not be all that surprising. But how are things going to change? Will levels of compliance go down and will motivations to comply shift as lockdown fatigue sets in, and/or as different transition from lockdown phases begin, or indeed if lockdown returns for certain periods, for current groups? Watch this space!

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About the Authors

Jonathan Jackson is Professor in Research Methodology and Head of the LSE Department of Methodology.

Chris Posch is a Postdoctoral Research Fellow in the Department of Methodology at LSE.

Ben Bradford is Professor of Global City Policing in the Department of Security and Crime Science at UCL.

Zoe Hobson is a Researcher in the Department of Security and Crime Science at UCL.

Arabella Kyprianides is a Research Fellow in the Department of Security and Crime Science at UCL.

Julia Yesberg is Research Fellow in the Department of Security and Crime Science at UCL.

LSE blog

To protect older people from COVID-19, state coordination of the social care sector is urgently needed

As COVID-19 rips through our social care sector, now is the time to put an end to the highly fragmented social care market and for the NHS and local government to step in to provide coordination, writes David Rowland. The arguments for doing so are becoming more compelling by the day.

Using the market to deliver social care on a low-cost basis had manifestly failed even before the current pandemic: one in five care homes are rated as inadequate or needing improvement, personal care is provided to people in their own homes in 15-minute slots, with the sector as a whole suffering from a 30% turnover rate – a fact which might explain why there are currently over 120,000 vacancies.

But this market failure, whilst tolerated by politicians of all parties for over 20 years, is fast becoming the cause of a national tragedy. Due to the fragmented nature of social care provision, it is almost impossible to say what is happening to these older people. Within one local authority, as many as 800 different care businesses are delivering vital care services at any one time, making it all but impossible for public health teams to track and monitor the spread of the disease across these providers.

At a national level, the data on care home deaths and infection rates is appearing in the media on a company-by-company, and sometimes home-by-home basis with seemingly no standardised method of reporting. The care regulator has only just started collecting data on deaths caused by COVID-19, some four weeks into the crisis. And family members are often unable to visit their loved ones and so are unable to see what kind of care they are receiving.

And because care home companies exist as separate businesses, in competition with one another, it is difficult if not impossible for them to collaborate to jointly procure protective equipment, or to re-allocate staff members from one home to another to cover sickness absences. The success of one care provider in getting access to PPE or staff cover is to the detriment of another, and without state support it is impossible to develop additional care facilities so as to isolate those who are infected from those who aren’t.

Moreover, the care workforce has become so casualised that care workers will sometimes work in more than one care setting – providing care services in someone’s home one day, whilst working in a residential care setting the next – thus potentially increasing the spread of the disease amongst those who are most vulnerable. The reliance on zero-hours contracts, particularly in the home care sector where nearly 60% of workers operate on such terms, also heightens the risk that those workers who are sick with the virus are unable to afford to stay at home and isolate.

Because the state has driven the cost of delivering care down to a bare minimum, and because offshore investors have sought to extract the maximum short-term profit out of the residential care sector, many care provider companies were teetering on the brink of collapse even before COVID-19 hit. This has left the financial structure of the industry in such a fragile state that it is not able to withstand even a minor downturn in income or increase in costs.

When the relatively mild winter flu hit in 2017, one of the largest and most financially troubled care providers, Four Seasons, reported that its profits had been badly hit due to a 2% decline in occupancy rates caused by an increase in deaths amongst the older population.  The government’s impact assessment on a no deal Brexit, published in 2019, predicted that an increase in inflation would cause the care sector to fall over. And the home care industry was also found to be loss-making even before the pandemic, with a quarter of all businesses at risk of insolvency. 

But these shocks are nothing compared to the sustained impact of coronavirus over an 18-month period – the increased hygiene and cleaning requirements, PPE and staff costs which come with dealing with this crisis, and the fall in income and occupancy due to the tragically premature deaths of large numbers of older people. All these mean that the sector is heading towards financial collapse.

The government’s plan for the social care sector, published in late April, works on the assumption: that it can turn the social care system round by building on this dysfunctional market structure. It sets out plans to provide greater amounts of PPE for staff, to increase testing, and to recruit more care workers alongside an additional £1.6 billion of funding. But these are only the very basics that the system currently needs to deal with the impact from COVID-19.

The government’s plan does nothing to address the high likelihood of provider failure, instead relying on the sector regulator’s ‘market oversight regime‘, which merely warns local authorities if a major provider is about to go bust but does nothing to prevent it.  And it says nothing about addressing the highly precarious employment status of the workforce. Whilst acknowledging that a quarter of care workers are on zero-hours contracts, the government proposes to do nothing to provide them with any additional security, which might prevent them from working when sick and endangering the people they are caring for.

Unlike in the NHS, where the Secretary of State has legal powers in an emergency to issue commands and in effect suspend the operation of the NHS internal market, no similar powers exist in relation to the social care sector. Yet it is becoming clearer that it is impossible to effectively respond to a public health emergency of the current magnitude by relying on market-based provision.

At the very least, local authorities and the NHS should be given the legal powers to take over direct responsibility for providing care in people’s homes, where this can be justified on public health grounds, and to also, if necessary, take back publicly-funded contracts for home care and employ the home care workforce directly as part of the NHS or the local authority.

The NHS and local authorities should also have powers to issue directions to all care providers where there are concerns about their ability to respond effectively to the virus, irrespective of whether the recipients are private payers or are state funded. Publicly-funded capital should be quickly made available to allow the NHS or local authorities to open new homes to provide additional facilities in order to shield vulnerable people. Where care homes are at risk of going bust, local authorities and the NHS should have the right to step in and run the facilities, rather than having to re-house residents at very short notice as currently happens.

Arguments about the state’s long-term role in directly providing social care services and the funding arrangements for social care can wait until this crisis is over. For now, the NHS and local authorities need levers to coordinate social care provision in order to have the best chance of minimising the harm to our older population.

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About the Author

David Rowland is the Director of the Centre for Health and the Public Interest. Prior to this he worked within healthcare professional regulation in the UK as the Head of Policy at three national regulators and has developed significant expertise in social care policy, NHS workforce issues, regulation, safeguarding, whistleblowing and patient safety.

LSE blog

The Tories must not reward tax-dodgers with ‘no strings attached’ bailouts.

Government bailouts must not enrich tax dodgers, writes Prof. Prem Sikka

The UK government is bailing out companies affected by the coronavirus pandemic. What do the public get in return?

The initial kitty of £330bn worth of government-backed loans has been supplemented by the Bank of England’s quantitative easing programme of another £200bn to purchase corporate bonds.

The corporate queue for bailout includes airlines, pubs, restaurants, clothing, oil/gas and numerous other sectors. Take EasyJet. The UK government has given a £600m loan to the company. But the terms of the loan are secret, which means that the public and parliament can’t easily call the government or the company to account.

In the normal course of events, companies must ask their shareholders for additional funding when in distress. After all, they have been receiving dividends, share buybacks and other forms of returns for years. Between 2011 and 2018, the UK’s biggest companies paid out £400bn in dividends and £61bn in share buybacks to shareholders. Now most want to provide little/no additional investment. This includes billionaires like Sir Richard Branson and Sir Philip Green.

Choices

If shareholders fail to invest, the company can enter administration, and its control effectively passes to bondholders, or secured creditors – mostly banks and private equity. They can convert their bonds/debt to equity, and effectively become shareholders and nurse the business.

This means that the entity is no longer obliged to make interest payments on its debt and can preserve its cash flow. It seems that many bondholders do not want to exercise this option. In the final analysis, an insolvency administrator can seek buyers for the business. If that option does not materialise then liquidation and a piecemeal sale of assets beckons.

Other countries are given far more thought to the issue of bailouts. For example, Denmark and Poland have stated that companies registered in tax havens are not eligible for any government bailout funds. After all, they did not directly contribute to the public purse and therefore have no moral right to make a claim on it. The UK must also follow the same principles and refuse to reward elites or companies who excelled at dodging taxes and their social responsibilities.

The case of Virgin

Such principles can help to deal with the £500m Government-backed loanand credit guarantee sought by Virgin Atlantic. US-based Delta Airlines holds 49% of the company’s shares. The ultimate holding company of Virgin Atlantic is Virgin Group Holdings Limited, a company registered in the tax haven of British Virgin Islands (BVI). Its sole shareholder is BVI-resident Sir Richard Branson. Therefore, he holds 51% of the shares of Virgin Atlantic. BVI provides opacity and does not levy corporation or income tax.

Virgin Atlantic should ask its shareholders for additional funding. With an estimated wealth of £4.7bn, Sir Richard – a self-confessed tax-exile – should provide additional funds. He controls numerous companies, including Virgin Care which has £2bn of NHS and local authority social care contracts but has not paid UK corporation tax. The company is ultimately controlled through BVI registered Virgin Group Holdings Ltd. Virgin Group has collected £306m in dividends from Virgin Trains.

Two years ago, Sir Richard sold part of his stake in Virgin Money to Clydesdale Bank and Yorkshire Bank for £1.7bn. The new owners also pay Virgin Group £12m a year, rising to £15m, for the licence to use the Virgin Money brand.

Sir Richard has resources. Even his paper-wealth can be used as collateral to generate funds – but he shows little appetite for that.

If Sir Richard decides to abandon Virgin Atlantic, then bondholders can step-in. If they show no interests then the company should ask BVI for support. It is hard to see any moral case for the UK to rescue Virgin Atlantic and enrich a tax-exile who has carefully crafted his personal and business affairs to avoid UK taxes. Of course, the UK government can buy the airline from administrators at a low price to preserve jobs.

Getting something back

The UK government needs to state the principles which will guide its bailouts. They must be based on social responsibility. Currently, the UK government is subsidising 80% of the employee wages, up to a maximum of £2,500 per month, until June. After that unemployment is likely to spike. To prevent that, bailed out businesses must guarantee not to cut jobs for the next 12 months.

Bailouts should be used to bring essential industries under public ownership. In return for bailout funds, the recipients must terminate all strategies for avoiding UK taxes and embrace socially responsible objectives.

These should include targets for reducing carbon emissions, gender and ethnicity pay gap; greater diversity in company boards and employee-elected directors on the boards of large companies. Companies must not haemorrhage cash through payment of excessive dividends. Director remuneration should be no more than 10 times the lowest wage in the company.

Any government bailout has to protect jobs, taxpayer and social interests. It must not reward bad companies or corporate elites who eye a sack load of money to enhance their own wealth. It’s time to see some strings attached.

Prem Sikka is Professor of Accounting at University of Sheffield and Emeritus Professor of Accounting at University of Essex. He is a Contributing Editor to LFF and tweets here.

The Great Virgin Train Robbery

ByStefan Bielik

After rail privatisation, Virgin Trains were presented as an engineering triumph – but they amounted to nothing more than a sewage-scented rebranding of British Rail’s managed decline.

Since Britain’s rail network was privatised in the mid-1990s, the matter of its return to state control has dogged the country’s left. British commuters have been forced to watch on as European neighbours modernised and pushed forward technologically, while their own network was left to rot in the hands of avatars for PFI and PPP like Richard Branson. As we pick through the aftermath of December’s catastrophe for the British left, considering what worked and what we ought to rethink, the renationalisation of the entire rail network should be one of the pledges we consider inarguable – as well as the more obvious reasons for government ownership, such as job creation and the potential for revenue generation, the demise of British Rail is an under-reported moment in the decline of the UK’s manufacturing industry. Simply put, reviving this would be one step towards regaining the mythologised days when the country Still Made Things, and draw manufacturing industries away from defence sectors, allowing us to head off nativist swerves by right-wing factions without compromising our values.

To illustrate, a name that will invoke instant recollections of a very specific smell to users of the West Coast Mainline – the Pendolino. Bought by Virgin Trains to serve its flagship route acquired in the mess of rail privatisation Britain underwent in the 1990s, these trains began serving the route in the giddy heights of the Blair years. Their fast acceleration, racing car nose and futuristic interiors were shown off in a typically vainglorious campaign, featuring plenty of shots of Richard Branson gurning and giving thumbs-ups out of driver’s cab windows. This press release hints in its corporate way at the excitement surrounding manufacturer ALSTOM ‘introducing tilting technology to the UK’ – but that is not, in fact, the truth, and overlooks a story which almost by itself makes the case for nationalised rail. 

The UK’s rail network, like so much of the country’s infrastructure, suffers from a problem of early adoption followed by a failure to continue innovating. Being pioneers in modern rail, the first to construct wrought iron tracks as well as introduce steam engines, has not led to sustained dominance in the industry. Contrary to other European leaders in the field such as Austria or Switzerland, both largely nationalised since the late 19th century, outside of wartime Britain’s trains did not come under state ownership until the Transport Act of 1947. This laid out plans to finally bring the four private companies, created by forced consolidation under previous Acts, under state control (of course, at this time it had not occurred to anyone to advocate separating track and rolling stock ownership, but more on that later). The initial period of private ownership had not been a barrier to the early expansion of routes, both freight and passenger, as profitability and relative usefulness of lines largely managed to happily coexist – indeed, the irony of nationalisation leading rather rapidly to the Beeching cuts, as opposed to the railways existing as a public good without the obligation to turn a profit, is often cited as proof that privatisation is best for Britain’s trains.

However, this is of course an argument that deliberately limits its scope. The fatal blows to Britain’s pioneering developments in locomotion were the combination of nationalisation with a succession of Conservative governments that seemed determined to prove the unworkable nature of state-owned rail, as well as a decision to prioritise motorways and other road construction – the Beeching Report even advocated transferring freight transport from rail to road. Consequently, while Japan was spending 400bn yen, or roughly £400m at the time, opening its pioneering Shinkansen lines in the mid-1960s, Britain was following up on the rail network cuts of the previous decade by pledging £1bn of investment in new trunk roads, just to ease car access into London. The country was moving firmly towards its model of suburban living, which reached full fruition by the 1980s. Reading’s Lower Earley – at one point the largest private housing estate in Europe – was archetypal. Endless roundabout junctions, the absence of a clear centre and no proper pedestrian routes to even access one, and crucially, almost no public transport connections – and certainly no rapid transit or light rail. What Lower Earley does have is a 5-minute drive to a motorway junction for almost all houses, and a dual carriageway directly into the town centre. It is, like hundreds of similar estates across the country, an area where it is near-impossible to live without owning a car. Even without the pernicious tactics of US car manufacturers (buying tram companies in order to close the lines, as happened across the USA), the UK managed to achieve a market ready-made for the motor vehicle industry.

This unwillingness to invest in grand public transport projects (at least, outside of London) left Britain with a network of railways largely built in an age when ‘high speed train’ meant something that travelled at a top speed of around 125kph (78mph). By the beginning of the 1970s, following the Shinkansen’s initial success as it took passengers between Tokyo and Osaka for the 1964 Olympic Games, then over 100m passengers in the following 3 years alone, other countries began to take interest in the potential for mass transit at high speeds. In Britain, it would not be a simple, or cheap task however. To make the technical part as simple as possible, deployment of trains going faster than around 200kph (125mph) on older lines encounters three main problems: firstly, capacity – clearly, a train capable of travelling at over 200kph cannot maintain full speed on a line also used by freight and local passenger trains travelling at 90. Secondly, every high speed train in the world is equipped with an in-cab signalling system, allowing drivers to rely on computerised internal systems and automated braking systems rather than watching for trackside signals, thus removing the risk of error. Finally, the curvatures on British tracks would result in derailment for trains travelling at higher speeds, or at the very least extreme discomfort for passengers as lateral forces shift them in their seats. With the government clearly unwilling to embark on a costly network of more direct, fast lines, any plans for bringing Britain’s trains into the modern age seemed to be limited to the constraints of the existing network.

Therefore, in 1975, British Rail’s HST project rolled out the InterCity 125, a compromise that could achieve 125mph, albeit with far less acceleration than international competitors thanks to its diesel-electric engines. Like many stop-gap solutions in British infrastructure, these near-50 year old designs still form an important part of the country’s rolling stock today, but with a little more willing and investment, a project being worked on in the background could have led to a very different story.

In 1981, British Rail invited journalists to Glasgow for a trial run of a new type of train, a sleek, futuristic, electric train named simply APT – Advanced Passenger Train. Faced with adapting to the old network, designers and engineers came up with the solution of creating a technology that used sensors and computerised hydraulic systems to tilt into corners, thus enabling the train to maintain high speeds where traditional units would have had to brake. This technology had been in development for over two decades by this time, and despite that domestic fanfare (including a notorious PR video presented by Peter Purves) was not the first of its kind in the world – Fiat Ferroviara, the Italian firm’s rail division, had built an experimental Electric Multiple Unit capable of similar technological tricks and deployed it on the line from Rome to Ancona in 1975. It was nicknamed Pendolino – a diminutive version of the Italian word for pendulum – the first usage of that name. Back in Britain, BR hoped that the APT would help them compete with the burgeoning motorway network, as well as the rise of aeroplane travel between Britain’s more distant cities. As is clear from the absence of APTs from the modern rail network, this was not to be the case.

Things began to fall apart from that initial promotional ride. Despite Purves’ best attempts to talk at a normal volume over clattering crockery (“it’s smooth, and it’s quiet”) as the train tilts into another Victorian-era curve, and a best-ever time of 4 hours 15 minutes for the journey from Glasgow to London, the newspapers were full of reports of passengers feeling sick thanks to the constant rocking of the tilting system, and a sensation that can be summed up as the inverse of seasickness – ie, a perception of movement without the body experiencing correspondent effects. Soon after, a northbound service was suspended at Crewe thanks to a frozen braking system, and the problems continued until BR was forced to withdraw the train from service. Its time serving West Coast Mainline passengers had lasted under three weeks. Taken out of service, and sent for re-evaluation, the APT trains made a final, unheralded appearance from 1984 for a year or two, before this last gasp of British Rail’s development department was killed off for good. £50m had been spent on the project across its entire history.

Meanwhile, Fiat – an awkward case, given that they are a private company who benefit from close associations with the Italian state – were continuing research on the technology after the relative success of prototype experiments in Italy and Spain (through a collaboration with state-owned RENFE). Taking lessons from the failure of the British project, the project finally created a train suitable for regular passenger service in 1988, with ETR-450 models running initially from Rome to Milan. Of course, in this time France had opened its TGV, with SNCF invoking Aristotle in its inauguration (‘Le progrès ne vaut que s’il est partagé par tous’ – progress is worthless unless shared by all), reaching speeds unimaginable in the rest of Europe and doing so with at least the pretence of socialist ambition afforded by the Mitterand government. Spain was beginning construction on its own dedicated high-speed network, and Germany was progressing towards lightning speeds at a more measured, methodical pace through its Intercity Express network. Each of these focused on newly-built, dedicated lines, though – not something possible in the Major or Blair years of Britain, where large infrastructural projects were predicated on private sector investment and guaranteed income, as with the M6 Toll Road or Dartford Bridge. 

Virgin Trains, like all other products in the Virgin brand, was something that seems only possible in the “things can only get better” era of the late 90s. Concentrating solely on the sexier intercity routes, with their fast speeds and glamorous routes into the heart of London, owner Richard Branson did all he could to bring his personality to the distinctly dull world of rail transport. Bikini women, ticket discounts, Rik Mayall-fronted adverts (with an apparent brief to channel the train knight himself) – the British public were bombarded with efforts to entice them back onto trains and off the motorways. The problem was, no amount of presentation could hide a passenger experience involving 20 year old trains and hastily-repainted interiors, with slam doors, shaky rides and toilets that still emptied directly onto the tracks. The answer, inevitably, was the Pendolino. Those rounded-edge interiors, the space-age toilets that a good half of users failed to work out how to lock, sliding doors and, in the Branson rewriting of history, completely new technology in Britain finally gave Virgin an end product that matched their marketing. At this point, due to various corporate buy-outs, the trains (registered as BR Class 390) were produced by the French conglomerate Alstom, but that technology developed simultaneously by Italian and British engineers was still there. Of course, in a different timeline, these trains are deployed by British Rail far earlier after repeated testing thanks to sufficient investment levels. 

In our timeline, however, the Pendolino (and, in a stroke of bad luck, Virgin’s diesel equivalent Bombardier Voyager) was an adapted version of a technology developed for slightly different circumstances, and with more than a few design flaws. As far as passenger experience went, the most famous of these was the constant smell of sewage thanks to a construction flaw in the air intake system. On top of this, promised improvements to the line that would have allowed the train to operate at its top speed never materialised, thanks to any track work being in the hands of the disastrous, even fatally so Railtrack company. And yet in other countries, the technology was booming. Italy, Poland, Czech Republic, Finland, Slovenia among others – almost all, interestingly, with at minimum a retained state interest in the rail network – all by now use train units which trace their design back to those first BR and Fiat trials.

Of course, a continuing reliance on now 40-year old diesel trains is by no means the end, nor even the beginning of the list of problems with UK transport. A perfect storm of decades of under-investment (a tactic of ‘managed decline’ used effectively in this area as well as health services and of course the entire city of Liverpool) and the extreme centralization of the country’s economy have led to, London aside, a service that fails to meet the needs of its potential users. Those fortunate enough to live on a spoke from London to one of the cities deemed important enough to have a main line to the capital can generally rely on fast travel to other places along this route, but lateral travel between these lines is generally awful, thus increasing reliance on cars. 

Perhaps the most brutal example of this is to consider a trip between the Welsh coastal towns of Haverfordwest and Bangor, which would take under four hours by road. The train journey, however, involves at best a little over seven hours, a change at Cardiff and a decent amount of time across the border in England. Both of these places, of course, have much quicker train connections to London – indeed, Bangor has a faster connection to the UK capital than to Cardiff, the capital of its own nation. Compare this with, for example, a train between German provincial centres of Bremen and Rostock – a similar distance but with a journey time less than half that of the Welsh example above. 

Of course, the UK is not alone in having poor intercity connections outside of the capital – Spain suffers from a centralised hub-and-spoke model that for instance means the fastest route from Murcia to Malaga (again around 200 miles/320km) by train involves first travelling to the central province of Castile. Spain here has the excuse of being ruled by a fascist, Madrid-focused government for 40 years. France meanwhile has since World War II strived to ensure an even economical distribution around the country – indeed, the TGV project was arguably as much about ensuring fast routes for northerners going on holiday as it was about ensuring non-Parisians could get to Paris quicker. But it’s within metropolitan areas that the difference between Britain-outside-of-London and everywhere else is largest. Suburban S-Bahn systems can be found in most major cities of central and western Europe – from Kraków and Ostrava to Stuttgart and Le Havre, those living in peripheral estates and villages can still rely on regular commuter trains to their regional centre. In Britain, the ‘Northern Powerhouse’ capital of Manchester is served from Bolton and the Peak District, natural feeder areas, by one of the most infamous projects in British rail history, the bus-on-rails Pacer. 

As a country led by the party most responsible for gutting its public transport prepares to embark on its most ambitious infrastructure project since the Channel Tunnel with HS2, it seems that we are no closer to a system that imagines users wishing to occasionally travel to somewhere other than London or a town on the way. The full, theoretical plans including HS3 or ‘Northern Powerhouse Rail’ go some way to righting this, albeit exclusively in England and with a best-case completion date of some 20 years hence. Compare that with China’s high-speed rail network, which through essentially applying mass-production principles to rail construction (and, admittedly, the world’s most plentiful supply of labour) has gone from having a single ‘fast’ line with a 100mph (160kph) limit in 1995 to thousands of miles of some of the highest-speed tracks in the world by now, and plans to continue expanding and improving. On top of this, the private Czech carrier Leo Express will this year deploy Europe’s first Chinese-designed trains, cementing the nation’s place as a major player in rail. It is worth noting that some of the greatest leaps forward in this journey were made during the global recession which started in 2008, thanks to the CPC’s economic stimulus packages. This isn’t just an economic concern, either – the net result of high-speed rail between important cities has a drastic effect on domestic flights and car journeys. Thanks to state ownership and thus a lesser incentive to turn direct profits, the Chinese government (just like the French before them) were able to aggressively price their tickets against airlines, and with centre-to-centre connections and no need to ‘check-in’, as well as the ability to work en-route, domestic car and plane journeys fell dramatically.

Some of the problems of Britain’s 19th century infrastructure are unsolvable without tearing everything down and starting again. The legacy of its train lines being built up by competing Victorian businessmen led to many oddities, such as Wigan’s two stations, or the five different answers you would receive to the question ‘what is the main station in London?’ But there are many more aspects that can and must be fixed – and it is clear from countless historical examples that this can only be done with bold, organised state planning, without profiteering.

Tribune link

Can’t, won’t and what’s the point? Explaining the U.K. public’s muted response to austerity

Since 2010, the government has undertaken extensive spending cuts, subsequently linked with rising poverty, food bank use, and serious health issues. Kate Harrison identifies key factors that explain why the public’s response to austerity has been relatively muted.

Since 2010, successive governments have instigated round after round of spending cuts, reducing or closing many public services. However, the government’s 2020 budget, followed by the spending necessitated by the COVID-19 crisis, appear to have brought an end to cuts, at least in the short term. Many, though, now faced with unemployment, are being forced to turn to government support such as Universal Credit. They have been met by a benefits system depleted by long-term underinvestment and face the reality of living on £94 per week, or less. Many who previously were shielded from austerity’s worst effects must now face the reality of it.

Under austerity, the UK has seen cuts to spending disproportionately spread across the country, with deprived areas typically facing the highest cuts to services. Over the last decade, child poverty has risen, foodbank referrals have more than doubled and health inequalities have widened. Those who are most in need have borne the brunt of the cuts: people with the most severe disabilities have faced a burden of cuts 19 times higher than the rest of the population.

Despite this, the public response to austerity has been relatively muted, with a spate of protests in the initial years of the coalition government and relatively little political activism since. My research looks at why there hasn’t been a stronger public response to these measures. Some argue that Brexit could have been a protest vote against the cuts and their consequences for many people. The evidence on this is so far limited, but it is still worth noting that if austerity did play a role in the UK’s vote to leave the EU, this is an indirect and nonspecific way of protesting the cuts. As such, it is important to understand why people are not taking more conventional approaches to opposing austerity.

Across many forms of political participation, including voting and protesting, it is typically those with low wealth, income, and education who are least likely to take part. Given that it is these groups who are suffering the most under austerity, without their voices being heard the political establishment are given no reason to change their policies. This maintenance of the status quo then allows the most powerful members of society to preserve their position of privilege.

The key question is therefore why are more people not expressing opposition to austerity? Research suggests that people need time, money and civic skills to participate. However, when there is an economic shock like the financial crisis of 2008, there can be a spike in protest behaviour as people express their grievances, such as a demonstrating against rising unemployment.

This theory of grievances as motivation for protest can explain the early protests the UK saw, such as Occupy London and student protests against rising tuition fees. Nevertheless, what this doesn’t explain is why these protests didn’t continue, as austerity deepened and public services were reduced or closed. This suggests the picture is more complex.

Building on the two theories mentioned above, I propose a four-fold explanation for the relatively low levels of political activity seen in response to austerity. The starting point will be the argument that resources like time and money are needed for political participation. Under austerity, those from disadvantaged and minority groups have lost out the most, meaning that those who already had the least time, money, and resilience have fewer resources now than they did before. As such, participating in politics is even less accessible for those with disabilities, on benefits, and low incomes than it was before the cuts began.

But what about those more fortunate, who had more resources and haven’t lost out in the same way? The theory of grievances suggests that those who have experienced an economic or political struggle will engage in political participation. For those whose experience of austerity has been less extreme and less personal, there is little cause for mobilisation. Indeed, following the introduction of harsh austerity measures in Spain, the participants in the wave of strikes and demonstrations that took place were disproportionately those affected. For the population as a whole, political engagement actually declined, on average, after the introduction of cuts.

There are two further factors that are important to consider for a more nuanced understanding of low political participation. Firstly, the government chose to talk about the cuts in a way that made them seem both necessary and unavoidable. They made arguments such as ‘we are not doing this because we want to, driven by theory or ideology. We are doing this because we have to’. Despite some arguing that austerity is, in fact, an ideological choice and not the only solution, the British public largely accepted the narrative that there is no alternative. This may have led to a sense that participation is futile, because the lack of a viable alternative means that political action is unlikely to result in change.

Also, for those most affected by the cuts, the government’s choice to evoke a ‘blitz spirit’ narrative of ‘sticking together as a country’ is likely to have come across as insensitive, if not insulting. The highly unequal way that cuts have been implemented is likely to exacerbate distrust in politicians who try to claim that we are in it together.

The final consideration in understanding the impact of austerity is the broader picture of participation. There is evidence that trust in politicians has been declining while discontent with democracy grows. The distrust in politicians and lack of political efficacy fostered by the government’s austerity narrative is therefore likely to exacerbate more general recent trends of declining political participation.

In combination, these factors will typically lead to lack of political participation through two possible avenues, shown in the figure below. Generalised dissatisfaction with politics forms a backdrop for all, undermining participation even before austerity began. For those significantly affected by austerity, opportunities to engage in politics are diminished by the loss of resources to participate caused by spending cuts. The ‘in it together’ rhetoric then fosters alienation from the government, further exacerbating the disinclination to participate.

Figure 1: Theoretical model to illustrate low political participation in response to austerity.

Meanwhile, for those on higher incomes and less dependent on public services, the low personal impact of austerity produces no significant grievance to communicate, resulting in little motivation to act. Additionally, the rhetoric of austerity as necessary and unavoidable fosters the belief that nothing would change if they were to act. While general participation levels are already falling, more provocation is needed for political participation.

This theory demonstrates the complex ways in which people can become silenced by austerity, which is deeply problematic because those who are most dependent upon the state face the most challenges in engaging with politics. Those on low incomes, with disabilities or otherwise marginalised have lost out the most and, with their influence further diminished, are only likely to lose out more.

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Note: the above draws on the author’s published work in Representation.

About the Author

Kate Harrison is a PhD Researcher at the University of Southampton

LSE blog

Florence Nightingale would have recognised the challenges associated with COVID-19

Andrew Street outlines four reasons why it is apt that the temporary hospitals set up in response to COVID-19 are named after nursing pioneer Florence Nightingale. He explains how some of the key challenges currently facing UK healthcare professionals are similar to those Nightingale had to deal with.

It is fitting that the exhibition and convention centres rapidly equipped in the UK to house those suffering coronavirus are named Nightingale hospitals. This year marks the 200th anniversary of Florence Nightingale´s birth on 12 May 1820, and there are several echoes from her career to the current crisis.

Counting deaths

For starters, take the controversy in trying to establish how many people have died from coronavirus. Most countries are still counting only those who died in hospital having tested positive for COVID-19, not those dying in care homes or elsewhere. And there remain questions about whether a positive test for COVID-19 should be considered the cause of death or just a contributory factor.

Nightingale faced a similar problem in her role as superintendent of the female nursing team working in the English general military hospitals in Turkey. On arrival in Scutari in November 1854, she found three separate registers of those dying in hospital: the Adjutant’s daily head-roll of soldiers’ burials, the Medical Officers’ Return, and the Orderly Room return, all of which gave a different account of the number of deaths. She soon set about rectifying this ‘statistical carelessness‘ in order to record accurately how many soldiers had died. Unfortunately, we are still a long way from being able to compare meaningfully the death toll from coronavirus between one country and another.

Classifying diseases

On returning to England in 1856, Nightingale realised that each hospital had its own approach to recording information about its patients. So she created Model Hospital Statistical Forms which were recommended for widespread adoption in 1860 at the London meeting of the International Statistical Congress.

Nightingale had the forms printed and hospitals started using them. Guy´s Hospital published details of its cases from 1854 to 1861, including a table reporting 15 Classes of Diseases and another reporting Causes of Accidents, categorised into 22 groups. Group 21, for example, records all those hospitalised having suffered ‘Bites of animals, 7 dogs, 2 adders, monkey, horse, rat, elephant, and woman’, revealing a somewhat surprising assortment of assailants on the streets of London back then or indeed whenever.

From 1862, hospitals in London began to publish their data annually in the Journal of the Statistical Society of London. By 1866, the fifth and final year that the series was published, the statistics covered 29 hospitals across England. Publication ceased after a committee formed by the Royal College of Surgeons ‘reported adversely upon Miss Nightingale’s Forms‘ claiming it was too costly to collect the data and to make valid comparisons.

Nightingale´s ideas were eventually resurrected by Jacques Bertillon whose system was adopted in 1900 as the first International Classification of Causes of Death. In June 2018, the World Health Organisation launched the 11th revision, now known as the International Classification of Diseases and, on 25 March 2020, issued emergency ICD-10 and ICD-11 disease and cause of death codes for COVID-19.

Protecting staff

Nightingale herself used data about those who suffered disease and died to push for improvements in care – both for patients and staff. In 1858, one of her papers with William Farr was presented at the Liverpool meeting of the National Association for the Promotion of Social Science comparing mortality rates of hospital nurses with civilian women of a similar age. She identified a higher mortality rate among nurses, demonstrating that they had greater exposure to fever and cholera. She used the data to maintain her pressure on hospitals to improve hygiene and to provide better protection of staff.

She also urged hospitals to keep a register to support a superannuation fund for nurses. If adopted, her nursing register would have recorded the name, age, employment dates, reason for and state of health upon leaving the service, and date and cause of death for those dying in service. Surprisingly even today, this information is not always readily available: on 2 April 2020, the chief executive of the Royal College of Nursing complained to the Secretary of State for Health and Social Care about the difficulty of getting data about the number of nurses dying from COVID-19. Nightingale would have shared the chief executive’s indignation, stating that ‘money cannot replace … the loss of a well-trained nurse by preventable disease‘. An unforgivable failure by governments the world over in dealing with coronavirus has been that health workers have been inadequately protected from contagion.

Building hospitals

Perhaps the most compelling reason for naming the new coronavirus hospitals after Nightingale is because she ‘revolutionalised ideas of hospital construction‘. Her collected Notes on Hospitals, published in 1863, contained a detailed critique of defects in the construction and layouts of various hospitals in England, France, and Scotland and proposals that addressed these defects.

Nightingale’s ideas on hospital design meant that her advice was sought about the building of civic hospitals throughout the country and ‘upon the construction of military hospitals—whether general or attached to particular barracks—Miss Nightingale was consulted constantly and as a matter of course’. Given how much of her lifetime’s work was devoted to improving conditions for soldiers in the British Army, it is appropriate that military personnel have played such a key role in fitting out the coronavirus hospitals named in Nightingale´s honour.

Florence Nightingale devoted herself to evidence-based analysis of disease and health care ‘for the surer advance of medical knowledge and in the interests of good administration‘. Thanks in no small part to her efforts, our understanding of disease has improved enormously in the 200 years since Nightingale’s birth, as has our knowledge of how to provide effective care in safe environments. Even so, the corononavirus crisis has demonstrated the limits of our ability to combat new threats and that health and care systems still need strengthening to meet the demands being placed upon them.

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About the Author

Andrew Street (@andrewdstreet) is Professor of Health Economics in the Department of Health Policy at the London School of Economics and Political Science.

LSE blog

COVID-19 and free speech: ‘gagging’ NHS staff is not proportionate and lawful

George Letsas and Virginia Mantouvalou explain why any blanket restriction on NHS workers’ freedom of speech in the light of the pandemic is unlikely to pass the legal test of proportionality, or fit the image of a democracy that values transparency and accountability. 

‘I never thought I lived in a country where freedom of speech is discouraged’, wrote an NHS doctor to The Lancet. The journal receives many messages from front-line health workers who are being threatened with disciplinary action if they raise concerns about their safety at work. According to The Guardian, some NHS staff are altogether forbidden from speaking out publicly about the coronavirus. Intimidation techniques reportedly include threatening emails, monitoring of social media and disciplinary action.

This unprecedented restriction takes place against the background of secrecy surrounding the government’s response to the pandemic. There has so far been limited information both on the situation in hospitals and on the scientific evidence upon which the government acts. With Parliament in recess, the need for public scrutiny is even more pressing.

What is more, wars and pandemics have a substantial degree of a so-called ‘chilling effect’ on free speech: people typically rally behind their leaders and feel reluctant to voice their criticisms, adopting a stance of self-censorship. Even in the absence of any legal restrictions, a pandemic is therefore likely to result in suppression of information and decreased levels of accountability.

NHS workers’ freedom of expression

Governments’ response to the pandemic across Europe, and the rest of the world, has been accompanied by unprecedented restrictions on freedom of movement and assembly. Such restrictions are in principle justified in a context of a public health emergency. Yet they cannot go unchecked. The Council of Europe released guidance to its 47 Member States on how to respond to the pandemic while respecting human rights.

The right to free speech is protected in Article 10 of the European Convention on Human Rights (ECHR). In Handyside v UK, the European Court of Human Rights said that its ‘supervisory functions oblige it to pay the utmost attention to the principles characterising a “democratic society”. Freedom of expression constitutes one of the essential foundations of such a society, one of the basic conditions for its progress and for the development of every man’. In Lingens v Austriathe Court stressed that the press has a right ‘to impart information and ideas on political issues just as on those in other areas of public interest. Not only does the press have the task of imparting such information and ideas: the public also has a right to receive them.’

NHS workers, like all workers, have a right to free speech. Restrictions on their rights through intimidation, monitoring of their social media, and disciplinary action may violate the ECHR directly, since the NHS is a public sector institution. Their right is protected strongly both when they speak to mainstream media and when using social media. It can be limited only if there is a legitimate aim (such as public safety and public health) and insofar as the limitation is proportionate. When applying the test of proportionality in assessing violations of the Convention, the European Court of Human Rights (ECtHR) has accepted that the special nature of some professions must be taken into account.

While certain restrictions on the right to free speech may legitimately be grounded on a duty of loyalty of the worker towards the employer, other restrictions are illegitimate. This is best exemplified by the strong protection of whistleblowers, in the UK Public Interest Disclosure Act 1998, the case law of the ECtHR and the Council of Europe Recommendation CM/Rec2014(7). The information that whistleblowers share has to reveal a threat or harm to the public interest. The recent guidance of the Council of Europe explicitly states that ‘the pandemic should not be used to silence whistleblowers’. Workers’ speech that reveals information on a harm to public interest is afforded maximum legal protection.

But what about NHS workers who simply share stories of the situation as they experience it, without seeking to make a public interest disclosure? The guidance accepts that free speech during the pandemic may be limited. It gives the following example: ‘exceptional circumstances may compel responsible journalists to refrain from disclosing government-held information intended for restricted use – such as, for example, information on future measures to implement a stricter isolation policy’. Here, a restriction on press freedom is justified because it prevents imminent harm. If journalists disclosed such information, then many people would try to make the most of the last few days or hours before the measures, spreading the virus and putting lives at risk.

Is the restriction proportionate to a legitimate aim? 

By contrast to the example above, there is no necessary link to harm in allowing NHS staff to share their day-to-day experiences. In fact, there is a lot to be gained: any shortcomings in the government’s approach (such as shortage of protective equipment) will come to light, putting it under pressure to correct them. It may also mobilise civil society to help the NHS effort. Finally and crucially, it will contribute towards holding the authorities into account. Pluralism is crucial not just for a democratic society, but also for a healthy society.

As there has been no official justification for why restricting the free speech of NHS staff is necessary, we can only hypothesise about the rationale. The Guardian article suggests that the aim is to ‘stop scaremongering when communications departments are overloaded with work at a busy time’. While this is legitimate, there is little reason to think that NHS staff can exaggerate the scale of the situation, not least because we know hospitals around the world are being tested to their limits. The issue countries face, including the UK, goes in the opposite direction: several people do not take the threat of the virus seriously enough, flouting the lockdown measures.

Another possible rationale is the protection of patients’ privacy. This is obviously legitimate, but NHS staff are well aware that they should not reveal patients’ identities. Sharing their accounts about their overall experience in the pandemic, however, does not necessarily involve revealing individual patients’ information.

But perhaps the real rationale behind gagging is this: if NHS workers start sharing their horrific experiences, this will undermine the public’s morale and trust in the NHS, and may even lead to social unrest. This rationale is very old, going back to the heavy restrictions on reporting during wartime.

Yet are not really at war and the analogy is problematic on many levels. It suggests that criticisms of the government’s approach are unpatriotic, because we all have to be united against an external threat. But the coronavirus is not a foreign enemy who will take advantage of any publicly available information about the shortcomings of the government. On the contrary, more information leads to increased scrutiny which, in turn, strengthens – rather than weakens – our ability to fight the epidemic.

As to the argument that sharing information about the situation in hospitals will undermine morale, it is deeply paternalistic. It assumes that the nation is not mature enough to understand that even the most advanced and prepared healthcare systems will be stretched by this horrible pandemic and that even the most professional and committed health workers will be challenged, physically and mentally, to treat all the patients. There is nothing unpatriotic about letting healthcare workers share their experiences, horrific as they might be, with the public, whose health they are desperately trying to protect.

It is legitimate, of course, to worry about the danger of civil unrest. If the government is perceived – in the eyes of the public – to be wholly incompetent to deal with the pandemic, we could conceivably be led to instances of unrest, violence or riots. But legal principles here are clear: there must be evidence of a clear and present danger before any drastic measures are taken to limit free speech and no such evidence exists at the moment. And the ban on some NHS staff speaking out appears to be indiscriminate: it does not only apply to images or reporting that may shock or outrage the public. It applies to any comment some NHS staff might want to make about their experiences in hospital. According to well-established human rights case law, indiscriminate and blanket restrictions on human rights are likely to be disproportionate, even if the aim is legitimate.

NHS workers need to be open about the challenges they face. Powerful testimonies help citizens understand the seriousness of the situation and emphasise the immeasurable contribution of NHS workers; they also help NHS staff themselves, many of whom are faced with a risk of post-traumatic stress disorder.

Even assuming that there is a legitimate aim, then, we are not convinced that gagging NHS workers passes the legal test of proportionality. The ban does not fit the image of a democracy that values freedom, transparency, and accountability. The chilling effect that the reported intimidations and threats of disciplinary action has on NHS workers’ speech has to be recognized and alarm us all. It raises questions about how open the government is to accountability and how much it values people’s lives.

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LSE blog

Note: a longer version of the above was first published on the UK Labour Law Blog.

About the Authors

George Letsas is Professor of the Philosophy of Law at UCL.

Virginia Mantouvalou is Professor of Human Rights and Labour Law at UCL.

Care home deaths: the untold and largely unrecorded tragedy of COVID-19

Deaths from Covid-19 among residents of care homes show a tenfold increase in the two weeks to 3 April, yet even this may be a considerable underestimate. Melanie Henwood explains that, while there will likely be an overall under-reporting of deaths during the pandemic, this is particularly marked with deaths that occur outside hospitals.

The grim accounting of the daily death total from Covid-19 continues. On 10 April, the daily UK figure climbed to 980 – the highest to-date – surpassing the highest daily deaths experienced in Italy and Spain which had been seen as the most severely impacted European countries. There has been some decline in daily deaths since, but it may be too soon to take any comfort from this or to see it as the start of a plateau.

However, the officially recorded Covid-19 deaths reported each day are only part of the picture as they are deaths that occur in hospital, and do not include any in the community or those in residential and nursing homes. There is growing concern that not only do the overall figures underestimate the actual deaths, but that they do so because they ignore the plight of people living and dying with the condition outside hospitals. It is important to know the full picture, not least because deaths in the community are both under the radar and have the potential to rapidly escalate. But it is also vital to address these wider deaths because they disproportionately impact on the oldest and frailest people, and to ignore them devalues the significance of those lives.

Evidence has been accumulating through social media commentary, but also through expert reporting, that the situation in care homes should be a matter of huge concern. In part the circumstances reflect the wider issues afflicting social care practice, particularly the shortages of Personal Protection Equipment (PPE), that have been widely identified. If care staff working in the community and in care homes have inadequate PPE, the potential for the infection to spread between people is enormous. Official reporting of the numbers of people dying in care homes from Covid-19 is increasingly being seen as a significant underestimate, and we may be looking at just the tip of the iceberg.

The data reported by Chris Whitty, the Chief Medical Adviser, on 13 April stated that there had been outbreaks of Covid-19 infection in one in seven care homes in England, and there were 237 deaths in care homes in England and Wales in the two weeks up to 3 April. But data from major providers of residential care paints a much worse picture: HC-One and MHA together operate 3% of care homes nationally, but have documented deaths of 521 residents in recent weeks.

This is not to argue that there is a conspiracy of silence or deliberate covering up of the evidence, although those views will become increasingly prevalent if the situation is not addressed. Yet it is apparent that the data collection and reporting are inadequate and likely to give false assurance that numbers are significantly lower than the reality. The Office for National Statistics (ONS) publishes provisional weekly registered deaths in England and Wales, but these figures are published 11 days after the week ends. Data up to 3 April 3 was released on 14 April and includes a breakdown of the numbers of deaths “where Covid-19 or suspected Covid-19 was mentioned anywhere on the death certificate, including in combination with other health conditions.” Between 20 March and 3 April in England and Wales, the number of Covid-19 deaths recorded in care homes rose from 20 to 217, a tenfold increase; deaths associated with Covid-19 occurring in hospices rose from two to 33; and those at home in the community from 15 to 136. Over the same period, those Covid-19 deaths recorded in hospital increased from 501 to 3,716. The total deaths from all causes recorded in that week – 16,387 – show an ‘excess mortality’ of more than 6,000 above what would normally be expected for this week of the year. Some 3,475 are directly associated with Covid-19 (according to death certificates), but in reality, many more may be.

There are good reasons to conclude that the numbers of Covid-19 deaths being recorded outside of hospitals are considerably underestimating the actual figures. International evidence is beginning to emerge, and analysis by the International Long-Term Care Policy Network across five European countries indicates that “care home residents have so far accounted for between 42% and 57% of all deaths related to Covid-19.”  If there is inadequate testing of both staff and care home residents for infection, it is obvious that recorded deaths will also underestimate the true figures. Care England (the representative body of independent care providers) has estimated that the number of care home deaths already is nearer to 1,000; around five times higher than the official ONS figure.

It is not just deaths that are important here, it is also about the care and conditions for people who are dying in the community. Increasingly, it is being reported that GPs are not visiting care homes and that residents who become infected (or suspected as being infected) will not be taken to hospital. With PPE shortages not only does this increase the risks that infection will sweep through residents, but that people will die in homes that may lack the expertise and experience to support people dying in respiratory distress. The experience for residents, and the associated trauma of staff trying to support them, are awful to contemplate. An open letter sent to the Secretary of State for Health and Social Care by the Alzheimer’s Society, Marie Curie, Age UK, Care England and Independent Age sets out the issue:

We’re seeing people [in care homes] being abandoned to the worst that coronavirus can do. (…) they are told they cannot go to hospital, routinely asked to sign Do Not Resuscitate Orders, and cut off from their families when they need them most.

This issue is about the numbers – about the transparency, completeness, and reliability of the data recording deaths associated with Covid-19, and where those deaths are happening. But more than this, the big issue is what the data – and who decides what is measured and reported – tells us about how the incidence and experience of death from Covid-19 is regarded. All deaths matter; deaths of the frailest and most vulnerable citizens should be viewed as equally sad. The argument that people have ‘lived their life’ or ‘would have died anyway’ is poor comfort for those dying alone, afraid, and in considerable distress. Deaths in hospital from this epidemic are shocking; those occurring behind the closed doors of care homes, hospices, and in people’s own bedrooms, are the untold and apparently largely unrecorded tragedy.

About the Author


Melanie Henwood is an independent health and social care research consultant.

LSE Blog

We must not return to the folly of right-wing economics after the coronavirus pandemic. Prem Sikka

Neoliberals will soon forget their hour of need and will want a return to the past. People must organise to obstruct that return.

Neoliberalism has been the dominant ideology of the western world for the last 40-50 years. Its proponents sought the destruction of the state and limit its capacity to do their bidding, which included deregulation and cuts in hard-won social rights for people.

For neoliberals, markets, privatisation and commodification of everything was the answer rather than building a just society to enable everyone to live a fulfilling life. They portrayed public services as a burden on taxpayers rather than a social investment. Since 2010, a much lower proportion of the gross domestic product has gone to the National Health Service. Thousands of nursing vacancies remained unfilled. The government imposed wage freezes on public sector workers to give tax cuts to corporations and the rich. The government policies made a few people rich but most people struggled to make ends meet.

The light-touch regulation reduced HMRC’s resources. Banks, accountancy and law firms excelled at devising complex tax avoidance schemes. Billionaire Sir Philip Green’s BHS used intragroup transactions and a labyrinth of opaque offshore companies to returns to shareholders. The major shareholder in BHS was Monaco resident Lady Green and she was not liable to any tax upon dividends and other income from BHS. Green was not alone. Sir Richard Branson, resident in British Virgin Islands, operates through a maze of offshore trusts and corporate structures. He is a self-confessed ‘tax exile’ and his businesses such as Virgin Healthcare have paid no tax. The above are just the tip of an iceberg which has depleted the public purse and possibilities of investment in social infrastructure. Every year HMRC fails to collect around £34bn-£35bn of taxes due to avoidance, evasion and errors. Other studies estimate the amounts to be between £58.6bn and £122bn a year.

The folly of the above haunts the UK. The government imposed a lockdown to control the spread of the deadly virus and most business activity came to a halt. Markets and tax havens have not bailed out anyone. The richest 1% of people in the UK owns the same wealth as 80% of the population, or 53 million people, but the rich have not bailed out anyone. Only the state is providing support for employees, the self-employed and businesses. Billionaires such as Sir Philip Green and tax exile Sir Richard Branson head the queue seeking taxpayer funded bailouts for their business empires. Only the hollowed-out state, underfunded public services and public purse now stands between neoliberals and economic oblivion.

Rich neoliberals are holed-up in their big mansions and private islands, but the daily risks of providing essential services are being borne by some of the most poorly paid people. These include nurses, paramedics, midwives, radiographers, care assistants, shop workers, refuse workers, delivery drivers, and postmen. Some of the lowest-paid public sector workers at HMRC and the Department of Work and Pensions are trying to get aid to people.

Neoliberals have long regarded anyone claiming social security benefits as scroungers. They have been content to see Statutory Sick Pay fixed at derisory £94.25 per week. We all remember how Ian Duncan Smith, former leader of the Conservative Party, boasted that he could live on £53 a week in benefits. With the spread of coronavirus, many middle-class neoliberals are facing the possibility of living of £94.25 a week and they don’t like it.

Some 42% of the UK adults survive on an annual income of less than £12,500 and draw little sympathy from neoliberals. The current national minimum wage for workers aged 25 and over is £8.72 an hour, which translates as £1,500 a month and the Institute for Fiscal Studies thinks it is too high. The government has responded to middle-class anxieties by fixing the wage subsidy, from the public purse, at maximum of £2,500 a month. This begs the question why the national minimum wage is set well below that level. If £2,500 a month, or £30,000 per annum is required for a decent life, how can society condemn a large proportion of the population to live on amounts less than that.

The UK is estimated to have around 320,000 homeless and successive governments have done little about it. With concerns about the spread of coronavirus infections, central and local government agencies have managed to house all of them. It just goes to show what can be done.

Neoliberals will soon forget their hour of need and will want a return to the past. People must organise to obstruct that return. The state needs to be mobilised to ensure that homeless people are never again thrown out on the street. Investment in public services and healthcare must be seen as a public good. Inequalities need to be reduced by checking tax avoidance and taxing wealth and redistributing the proceeds. Everyone needs a decent minimum income and the current minimum wage and social security benefits are not enough. A universal basic income, much derived by neoliberals, needs to be considered.

Prem Sikka is Professor of Accounting at University of Sheffield and Emeritus Professor of Accounting at University of Essex.

Coronavirus embarrassed Trump and Bolsonaro. But the global right will fight back.

Science and welfare are at the heart of this crisis – which is bad for right-wing populists. But they won’t be wrongfooted for long

The populist right has built their electoral strength on boisterousness and arrogant self-confidence. Yet, amid the coronavirus pandemic, figures such as Donald Trump, Boris Johnson and Jair Bolsonaro seem to be confounded. They are either desperately clinging to a narrative of normality (it’s just a flu), or have already been forced to make embarrassing U-turns acknowledging the gravity of the crisis.
Boris Johnson had to abandon the government’s “herd immunity” strategy when new scientific evidence made apparent its horrific human cost. He recently tested positive for the virus and is now accused of complacency and lack of leadership. In Italy, Matteo Salvini, leader of the far-right League party and former deputy prime minister, appears downbeat, unable to wear the robes of the responsible statesman this emergency calls for; his unabashed criticism of government has even earned him the label “unpatriotic”. In France, Marine Le Pen seems to have vanished altogether from the media, while Bolsonaro’s persistence in denying the crisis is leaving him increasingly isolated.
Will the coronavirus ‘kill populism’? Don’t count on it | Cas Mudde
In the US, Trump’s strategy has been zigzagging. After downplaying the significance of the virus for weeks, he was forced to declare a national emergency. Having backtracked last week, asserting that the lockdown would end by Easter to avoid damaging the economy, he has now conceded it will have to last until the end of April. It is true that his approval ratings have gone up, paralleling what happened with George W Bush after September 11. But Trump is clearly worried about the electoral consequences of a massive death toll and a recession that could see unemployment of over 20%.
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The difficulties experienced by national populists are unsurprising given they are no friends of the issues at the heart of this crisis: health, welfare and science. On the health front, the crisis reveals the folly of decades of underfunding and privatisation of the health system. Trump, Johnson and Salvini have embarrassing questions to answer in regard to their record as enemies of public healthcare. Furthermore, the crisis calls for a sea change in economic policy that is at odds with the ideological premises of national populism, which combines chauvinism on the cultural front and ultra-neoliberal policies on the economic front.
The glaring need for state protection of strategic national industries, starting with health equipment and pharmaceuticals, is no anathema for national-populists who have already embraced trade protectionism. But the populist right has strongly opposed welfare measures that are becoming a matter of necessity to avoid social catastrophe. Having repeatedly branded these policies as “dangerous” and “anti-patriotic”, these politicians find themselves in the embarrassing situation of having to espouse them.
Another skeleton in the closet is national-populists’ disparagement of science. The coronavirus emergency confronts us with a threat that is best understood and measured through the lens of science. Epidemiologists and virologists have acquired media prominence and the public has been diligently following their recommendations. It is not clear whether this will lead to greater public trust in science and an erosion of the anti-science attitudes that national populist leaders have toyed with. However, it can be expected that citizens will take more heed of the risks flagged by scientists, including the climate emergency, which is also bound to exacerbate the spread of diseases.
National-populists are well known for stoking people’s fears. But the fears now prevalent are not of the kind these leaders are best positioned to exploit. Due to the urgency of health and economic worries, migration – the populist right’s main enemy – has fallen in the list of priorities. Travel bans, and the fact that Europe and the US are the present focus of the pandemic, are leading to a drop in migration to these regions. In fact, we are now witnessing a historic reversal, with Mexico aiming to block the border with the US and African countries suspending flights from Europe, while UK farmers are organising charter planes to fly in farm workers from eastern Europe to prevent fruit and vegetables being left unpicked. However, if the global economic crisis results in a new wave of migration like that of 2015, this scenario could drastically change – national-populists will try to validate their narrative of cosmopolitan globalisation as a dangerous vector of all sorts of ills.
If the coronavirus crisis has momentarily disoriented the populist right, this does not mean it is vanquished. It would be misguided for the left to believe that this crisis will work out in its favour. The health crisis is bound to be followed by a deep economic crisis, more similar to the Great Depression than to the 2008 financial crisis, and the populist right has already demonstrated its ability to prey on popular despair and find social scapegoats for economic ills. It can be expected that it will go down the same road, if anything becoming even more vicious.
The authoritarian measures implemented on Monday by Viktor Orbán in Hungary, with the suspension of parliament and the introduction of government by decree, may be the shape of things to come. In Italy, Salvini had no qualms about applauding Orbán’s move. We are also likely to see an exacerbation of anti-Chinese rhetoric. Trump made no apologies for calling Covid-19 “the Chinese virus”, while Steve Bannon argued that Covid-19 is a “Chinese Communist Party virus”. Salvini has proposed that “if the Chinese government knew [about the virus] and didn’t tell it publicly, it committed a crime against humanity”, and allies in Brazil and Spain are adopting a similar line.
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Given the ties among national-populists, including their botched attempt to establish a “nationalist international” under the auspices of Bannon’s Movement, this synchrony should not be taken as accidental. It has all the look of a coordinated strategy to channel the rage and despair caused by the crisis’s brutal human and economic toll towards a racial and ideological enemy conveniently identified in the Chinese government. Along with self-proclaimed socialists, all opponents are likely to be smeared as “Chinese collaborationists”: centrist US presidential candidate Joe Biden has already been termed “China’s choice for president” by the conservative National Review.
What may be in store is thus something much worse than the populist right of the 2010s: an extreme right using the whole arsenal of the red scare and rightwing authoritarianism to intimidate opponents and defend its interests from demands for meaningful economic redistribution. Though it has been confounded by this crisis, the populist right has not been suppressed. It is just mutating.
• Paolo Gerbaudo is a political theorist and the director of the Centre for Digital Culture at King’s College London

Link to Guardian